An ounce of prevention: Stillwater Medical administrators address COVID, capacity and tents

Medical tents set up outside the Stillwater Medical Emergency Department to provide additional capacity for the weekend were not needed for patients but will stay up for the time being. As of Friday morning SMC reported it had no available staffed beds and was holding four patients in the ER who needed ICU care. Michelle Charles/Stillwater News Press

Stillwater became a symbol last week for Oklahoma medical systems stressed beyond capacity when news outlets showed firefighters erecting hospital tents in the parking lot next to Stillwater Medical Center’s emergency room.

In addition to tents supplied by the Oklahoma State Department of Health, volunteer medical staff answered the call for doctors, nurses and technicians.

The extra space and staffing was meant to provide capacity if needed over the weekend due to the Labor Day holiday and Oklahoma State University’s first home football game.

Either of those events has the potential to bring more patients to the ER; not a problem under normal circumstances. But current circumstances are far from normal.

“Our hope is that no patients will need to receive care in the outdoor tents, but if our ER becomes overloaded like we have seen most of this week, then we are prepared with space and personnel to provide triage and care,” the hospital said in a Facebook post Friday.

Luckily, the number of patients seen over the weekend didn’t require SMC to use the tents for overflow treatment areas, SMC Director of Public Relations Shyla Eggers said. They were staffed Saturday from noon until midnight in case they were needed.

The tents will stay up for the time being.

SMC President/CEO Denise Webber gave an update Friday on how SMC and its staff are handling the demands placed on them by the COVID-19 pandemic during a First Friday forum sponsored by the Stillwater Medical Foundation.

Webber addressed the emergency declaration Stillwater Mayor Will Joyce signed Thursday, which enabled local emergency management and health officials to call in extra resources from the State Department of Health and the Oklahoma Medical Reserve Corps.

Over the past three weeks, the hospital has seen a surge in patients, some of whom have COVID, Webber explained.

Those patients stay in the hospital longer – an average of 20-30 days, something that was rare before the pandemic. When a patient occupies a bed for an extended period, that resource is tied up and unavailable if someone else needs medical care.

“And that’s not just happening in Stillwater, that’s happening all over the state of Oklahoma and that’s happening in many parts of our nation …Over the past 72 hours, with all those beds being used … it was just too much,” Webber said. “… We were full, other state hospitals were full, we were trying to get people to other states, they were full. So we just began to think an ounce of prevention is worth a pound of cure. … Normally, we have the capacity, but we just haven’t had that.”

As of 9 a.m. Friday, SMC had no staffed beds available. All 15 ICU beds were in use, with seven occupied by COVID patients. All 33 medical/surgical unit beds were in use, with 14 occupied by COVID patients. Of the four patients on hold in the ER, one was a COVID patient needing an ICU bed and the remaining three were non-COVID patients who needed ICU beds.

Webber was joined by SMC Director of Infection Control Necia Kimber, who she said had been extremely busy for the past 18 months. Kimber has made herself available since the pandemic to provide information to area schools and government bodies as they planned COVID responses.

They explained that the Delta variant behaves differently than strains that spread across the U.S. in the first wave of the pandemic.

“It’s a much more intense virus,” Webber said.

A slide they presented from OU Center for Health Sciences showed the Delta variant spreads quickly because it causes an infected person to carry about 1,000 times the viral load seen in the original strain. Its ability to infect is about 50% greater than the Alpha strain, which was 50% greater than the original virus. Vaccinated people can also carry the virus and infect other people. Kimber said it’s the increased transmissibility that really worries healthcare providers.

“With the Alpha variant … if you had COVID, you spread it to one to two people,” she said. “With this Delta variant, if you have COVID, you on average spread it to eight to 10 people.”

When people go to crowded places, the chances of infecting others, who will then spread it among their contacts is dramatic, she said.

Kimber said SMC staff could look at people who were sick with the Alpha variant and try to predict when they might need more intensive care or to be put on a ventilator but with the Delta variant, the patients coming in are much younger – under 50 – and they get sicker more quickly.

“We don’t have that grace period to evaluate them every day and say ‘OK, it looks like Tuesday he may have to be put on a vent,’ we’re putting them on the vent quickly and they’re staying on the vent longer,” she said. “So we have lost some of the history that we learned with the Alpha variant. We’re learning a new kind of transmission.”

Kimber said medical personnel are learning that each variant has its own progression through the disease process.

Based on the testing of swabs sent to the Oklahoma State Department of Health, as of Thursday the Delta variant as responsible for 85% of the COVID-19 infections in the state.

They shared some troubling statistics about variant now driving most of the state’s infections.

Unvaccinated people are at the highest risk, making up 75-90% of hospitalized patients and deaths.

Kimber said that according to a recent report from Oklahoma Commissioner of Health Lance Frye, unvaccinated people made up 93% of hospitalizations and 96% of deaths.

Unvaccinated children are 2.5 times more likely to become infected with Delta, which has led to more pediatric infections, hospitalizations and deaths in that age group.

Although quantitative studies are pending, known treatments including monoclonal antibodies and convalescent plasma don’t appear to be as effective against the Delta variant.

Vaccines still appear to be the best line of defense, Kimber said. The effect of vaccines is “reduced but still powerful” against Delta.

Fully vaccinated people are 90% protected from death, 71-88% protected from hospitalization and 40 -60% protected from symptomatic infection.

Twitter: @mcharlesNP

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